OG 2.2
Anatomy of the Female Pelvis
OG 5.5 Intrapartum and Postpartum care
Class Senior Cycle 1
Course Obstetrics and Gynaecology
Code SC1 Obs
Title Obstetric Emergencies
Date April 2020
Department of Obstetrics & Gynaecology
Department of Anatomy
Royal College of Surgeons in Ireland
, Obstetric Emergencies
• Antepartum
– PET/ Eclampsia
– Placental Abruption
– Placenta Praevia
• Intrapartum
– Cord prolapse
– Uterine rupture
– Shoulder dystocia
– Acute uterine inversion
• Postpartum
– Massive obstetric haemorrhage/PPH
– Amniotic fluid embolism
Department of Obstetrics & Gynaecology,
RCSI
, Pre-Eclamspia (PET)
• Hypertensive disorders affect • Mild to moderate
10-15% of pregnancies – Hypertension ≥ 140/90mmHg
• Pre-eclampsia 3-5%; Defined – Proteinuria >0.3g/24hrs
– No biochemical dysfunction
as hypertension and
• Severe (1:200 women)
proteinuria
– BP ≥ 160/100mmHg
• 19 maternal deaths 2006- – Proteinuria often >1g/24hrs
2008 (CMACE) – Biochemical dysfunction (low platelets, raised
• Appropriate management LFTs )
– Clinical signs: oedema, headache, visual
reduces maternal morbidity
disturbances, epigastric pain, vomiting,
and mortality hyperreflexia, clonus
Department of Obstetrics & Gynaecology,
RCSI
, Pre-Eclamspia (PET) Definition
Diagnostic Criteria for Preeclampsia
Blood pressure
Systolic blood pressure of 140 mm Hg or more or diastolic blood pressure of 90 mm Hg or more on two
occasions at least 4 hours apart after 20 weeks of gestation in a woman with a previously normal blood
pressure
Systolic blood pressure of 160 mm Hg or more or diastolic blood pressure of 110 mm Hg or more. (Severe
hypertension can be confirmed within a short interval (minutes) to facilitate timely antihypertensive therapy).
and
Proteinuria
300 mg or more per 24 hour urine collection (or this amount extrapolated from a timed collection) or
Protein/creatinine ratio of 0.3 mg/dL or more or
Dipstick reading of 2+ (used only if other quantitative methods not available)
Or in the absence of proteinuria, new-onset hyper- tension with the new onset of any of the following:
Thrombocytopenia: Platelet count less than 100,000 3 109/L
Renal insufficiency: Serum creatinine concentrations greater than 1.1 mg/dL or a doubling of the serum
creatinine concentration in the absence of other renal disease
Impaired liver function: Elevated blood concentrations of liver transaminases to twice normal concentration
Pulmonary oedema
New-onset headache unresponsive to medication and not accounted for by alternative diagnoses or visual
symptoms
Anatomy of the Female Pelvis
OG 5.5 Intrapartum and Postpartum care
Class Senior Cycle 1
Course Obstetrics and Gynaecology
Code SC1 Obs
Title Obstetric Emergencies
Date April 2020
Department of Obstetrics & Gynaecology
Department of Anatomy
Royal College of Surgeons in Ireland
, Obstetric Emergencies
• Antepartum
– PET/ Eclampsia
– Placental Abruption
– Placenta Praevia
• Intrapartum
– Cord prolapse
– Uterine rupture
– Shoulder dystocia
– Acute uterine inversion
• Postpartum
– Massive obstetric haemorrhage/PPH
– Amniotic fluid embolism
Department of Obstetrics & Gynaecology,
RCSI
, Pre-Eclamspia (PET)
• Hypertensive disorders affect • Mild to moderate
10-15% of pregnancies – Hypertension ≥ 140/90mmHg
• Pre-eclampsia 3-5%; Defined – Proteinuria >0.3g/24hrs
– No biochemical dysfunction
as hypertension and
• Severe (1:200 women)
proteinuria
– BP ≥ 160/100mmHg
• 19 maternal deaths 2006- – Proteinuria often >1g/24hrs
2008 (CMACE) – Biochemical dysfunction (low platelets, raised
• Appropriate management LFTs )
– Clinical signs: oedema, headache, visual
reduces maternal morbidity
disturbances, epigastric pain, vomiting,
and mortality hyperreflexia, clonus
Department of Obstetrics & Gynaecology,
RCSI
, Pre-Eclamspia (PET) Definition
Diagnostic Criteria for Preeclampsia
Blood pressure
Systolic blood pressure of 140 mm Hg or more or diastolic blood pressure of 90 mm Hg or more on two
occasions at least 4 hours apart after 20 weeks of gestation in a woman with a previously normal blood
pressure
Systolic blood pressure of 160 mm Hg or more or diastolic blood pressure of 110 mm Hg or more. (Severe
hypertension can be confirmed within a short interval (minutes) to facilitate timely antihypertensive therapy).
and
Proteinuria
300 mg or more per 24 hour urine collection (or this amount extrapolated from a timed collection) or
Protein/creatinine ratio of 0.3 mg/dL or more or
Dipstick reading of 2+ (used only if other quantitative methods not available)
Or in the absence of proteinuria, new-onset hyper- tension with the new onset of any of the following:
Thrombocytopenia: Platelet count less than 100,000 3 109/L
Renal insufficiency: Serum creatinine concentrations greater than 1.1 mg/dL or a doubling of the serum
creatinine concentration in the absence of other renal disease
Impaired liver function: Elevated blood concentrations of liver transaminases to twice normal concentration
Pulmonary oedema
New-onset headache unresponsive to medication and not accounted for by alternative diagnoses or visual
symptoms
